**6.2 The role of adequate sleep and good sleep hygiene in the management of diabetes mellitus**

Sleep is important for good health and adequate sleep is important for the management of sleep. Sleep may be defined as a state of unconsciousness in which the body rejuvenates itself and the soul is also nourished [15]. During sleep there is a healing of the physical body leading to the enhancement of health. The prescribed amount of sleep required daily is eight hours within 24 hours and at least 30 minutes of nap in the afternoon [15]. When sleeping, stress reduces including regaining energy and strength after tiredness as there is a reduction in the levels of hormones released during stress such as cortisol. Poor sleep or insufficient sleep can cause deleterious effects on the body, especially mental and physical health. Sleep is necessary for the regulation of several physiologic functions and processes. Some of these processes are related to the regulation of metabolism including the metabolism of glucose in the body [40]. The human mind and body need sleep to function healthily [41]. Several factors affect sleep including stress. In the management of diabetes mellitus, adequate sleep is important [42] as it is required for the effective maintenance of good glycaemic control [33]. In Type 2 diabetes mellitus, there is a

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*The Role of Lifestyle Medicine in the Management of Diabetes Mellitus*

correlation between glycaemic control and disturbances. In sleep, as evidenced by epidemiologic studies, although the extent remains unclear [42]. Results of some studies have shown that loss of sleep causes an increase in calorie intake within 24 hours [40]. Although there is a novel discovery that insufficient sleep has been associated as an important risk factor for the development of diabetes mellitus,

Some other studies have investigated the association between diabetes mellitus and sleep apnoea, have revealed that autonomic neuropathy may be the reason for a dysfunction in the central respiration control of the diaphragm and also a decrease in the upper airway [16]. Also sleep apnoea in diabetes mellitus may also be related to obesity, as obesity is a risk factor for diabetes mellitus and sleep apnoea in a study by Bing-Qian et al. [33] on the impact of the quality of sleep on glycaemic control on patients with Type 2 Diabetes Mellitus, there was no significant relationship seen between the sleep efficiency and glycaemic control [1] although the researchers acknowledged that good sleep is necessary for improving the quality of life of diabetics. In a systematic review and meta-analysis on the impact of the amount of sleep and quality of sleep on glycaemic control in Type 2 Diabetes Mellitus, there was not enough evidence to conclude to relate the quality of sleep and the level of glycosylated hemoglobin although it was found that higher levels of glycosylated hemoglobin were seen in diabetics with sleep disturbances the glycosylated hemoglobin was not affected by disturbed sleep [42]. However glycaemic control in patients with Type 2 Diabetes Mellitus is disrupted with too much or too little sleep. According to Surani et al. [41], there is a disruption in the glycaemic control following impaired quality of sleep which may have some deleterious effects on the body and the quality of life [42] as poor sleep leads to impaired decision making, loss of concentration. This will affect taking decisions on healthy food choices hence patients will choose unhealthy habits that will worsen the glycaemic control and overall management of the patients. In diabetics, there is speculation that reduced quality and duration of sleep can affect glucose control negatively [41, 43]. Also poor sleep in diabetics may be due to poor glycaemic control leading to poor quality of sleep which is required for the general wellbeing of every human being [43]. Hence for good glycaemic control, good sleep hygiene is necessary [15]. As sometimes disturbance of sleep may be an unrecognized health issue in diabetics.

**6.3 The role of increased physical activity and exercise in the management of** 

Physical inactivity and sedentary lifestyle are one of the risk factors for noncommunicable diseases and obesity and obesity is a risk factor for diabetes mellitus. There are short and long term advantages of physical activity including exercise and this cause a reduction of illnesses with obesity and physical inactivity as its predisposing factors including diabetes mellitus [24]. According to the results of several meta-analytical epidemiological studies on physical exercise including the Diabetes Prevention Programme (DPP) in the United States, diet and exercise and other components of lifestyle medicine causes a reduction in the progression of impaired

During physical activity and exercise, it acts as physical stress on the body thereby leading to changes in the transportation of glucose thereby satisfying the increased energy demand that occurs during exercise [8]. Hence among the core components of lifestyle medicine in the management of diabetes mellitus [12]. Results of some observational studies have revealed that one of the non-invasive therapies for the prevention and management of diabetes mellitus is exercise; this extends to pregnant women, hence exercise also serves as a preventive measure and

glucose tolerance (IGT) in Type 2 Diabetes Mellitus [44].

*DOI: http://dx.doi.org/10.5772/intechopen.99555*

these studies are not yet conclusive [40].

#### *The Role of Lifestyle Medicine in the Management of Diabetes Mellitus DOI: http://dx.doi.org/10.5772/intechopen.99555*

*Type 2 Diabetes - From Pathophysiology to Cyber Systems*

changes in the mechanism of metabolism of glucose. Chronic exposure to stress has several deleterious effects on the body [33]. The rise in the blood glucose following stress is not associated with physical stress alone but with any form of stress including emotional and psychosocial stress [34], which may be experienced daily.

There is an undiagnosed and underestimated incidence of depression, anxiety, the stress in diabetics [32], and there is a correlation between these mental problems with non-communicable diseases including diabetes mellitus. Some diabetics have co-morbid mental health disorders that are not recognized by the physician hence they are not diagnosed [32]. In a case–control study conducted by Krishna [34] among Type 2 diabetics on depression, anxiety and stress, there was a lower level of depression, anxiety and stress in the healthy controls compared to those diagnosed with diabetes mellitus as the diabetics had a higher incidence of depression, anxiety and stress. Hence, stress management is key in diabetes mellitus management.

Emotional problems are common in diabetics and diabetics are at risk of various emotional and psychological problems such as depression, anxiety and diabetesspecific distress [35]. One of the sources of distress in diabetes is the lifelong treatment which is required [36]. Faridah et al. [36] in their study on the relationship between emotional distress and quality of life of patients with Type 2 Diabetes Mellitus used the diabetes distress scale for their study. In this study, a significant relationship was observed using linear regression between emotional distress characteristics p-value >0.05 [36]. There was a positive relationship between glycaemic control and emotional distress in another study conducted by Strandberg et al. (2019) [37] where 319 adults with Type 1 diabetes mellitus were studied. This study proposed that during every clinical consultation with a diabetic, depression and

diabetes specific emotional distress should be watched out for [37].

In a South African cohort study conducted to investigate distress related to diabetes mellitus in patients with Type 2 Diabetes Mellitus, diabetes distress scale was used for this study. Distress was seen in 44% of the study participants [38]. This study recommends that attention should be paid to the psychological requirements of the patients as it has a great impact on the outcome of the disease [38]. In a randomized trial of Type 2 Diabetes Mellitus by Survit et al. [39], a significant reduction in HbA1c occurred following education on stress management (0.5%). There was a lower level of the HbA1c after one year in subjects who were educated

**6.2 The role of adequate sleep and good sleep hygiene in the management of** 

Sleep is important for good health and adequate sleep is important for the management of sleep. Sleep may be defined as a state of unconsciousness in which the body rejuvenates itself and the soul is also nourished [15]. During sleep there is a healing of the physical body leading to the enhancement of health. The prescribed amount of sleep required daily is eight hours within 24 hours and at least 30 minutes of nap in the afternoon [15]. When sleeping, stress reduces including regaining energy and strength after tiredness as there is a reduction in the levels of hormones released during stress such as cortisol. Poor sleep or insufficient sleep can cause deleterious effects on the body, especially mental and physical health. Sleep is necessary for the regulation of several physiologic functions and processes. Some of these processes are related to the regulation of metabolism including the metabolism of glucose in the body [40]. The human mind and body need sleep to function healthily [41]. Several factors affect sleep including stress. In the management of diabetes mellitus, adequate sleep is important [42] as it is required for the effective maintenance of good glycaemic control [33]. In Type 2 diabetes mellitus, there is a

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on stress management [39].

**diabetes mellitus**

correlation between glycaemic control and disturbances. In sleep, as evidenced by epidemiologic studies, although the extent remains unclear [42]. Results of some studies have shown that loss of sleep causes an increase in calorie intake within 24 hours [40]. Although there is a novel discovery that insufficient sleep has been associated as an important risk factor for the development of diabetes mellitus, these studies are not yet conclusive [40].

Some other studies have investigated the association between diabetes mellitus and sleep apnoea, have revealed that autonomic neuropathy may be the reason for a dysfunction in the central respiration control of the diaphragm and also a decrease in the upper airway [16]. Also sleep apnoea in diabetes mellitus may also be related to obesity, as obesity is a risk factor for diabetes mellitus and sleep apnoea in a study by Bing-Qian et al. [33] on the impact of the quality of sleep on glycaemic control on patients with Type 2 Diabetes Mellitus, there was no significant relationship seen between the sleep efficiency and glycaemic control [1] although the researchers acknowledged that good sleep is necessary for improving the quality of life of diabetics. In a systematic review and meta-analysis on the impact of the amount of sleep and quality of sleep on glycaemic control in Type 2 Diabetes Mellitus, there was not enough evidence to conclude to relate the quality of sleep and the level of glycosylated hemoglobin although it was found that higher levels of glycosylated hemoglobin were seen in diabetics with sleep disturbances the glycosylated hemoglobin was not affected by disturbed sleep [42]. However glycaemic control in patients with Type 2 Diabetes Mellitus is disrupted with too much or too little sleep.

According to Surani et al. [41], there is a disruption in the glycaemic control following impaired quality of sleep which may have some deleterious effects on the body and the quality of life [42] as poor sleep leads to impaired decision making, loss of concentration. This will affect taking decisions on healthy food choices hence patients will choose unhealthy habits that will worsen the glycaemic control and overall management of the patients. In diabetics, there is speculation that reduced quality and duration of sleep can affect glucose control negatively [41, 43]. Also poor sleep in diabetics may be due to poor glycaemic control leading to poor quality of sleep which is required for the general wellbeing of every human being [43]. Hence for good glycaemic control, good sleep hygiene is necessary [15]. As sometimes disturbance of sleep may be an unrecognized health issue in diabetics.
